[Dyspnea and cardia cancer, an unusual etiology]. / Epanchement péricardiaque : une cause peu ordinaire de dyspnée dans le décours d'une néoplasie du cardia.

CASE REPORT: a 63-year old man, followed for a metastatic cardia cancer, develop a pericardial effusion with sign of pre-tamponade. A CT scanner suggests the presence of a gastro- esophageal-pericardial fistula. A surgical drainage brings a purulent fluid, infected by a polymicrobial flora. Despite early antibiotics with vancomycin and piperacillin-tazobactam, the patient dies five days after the drainage. DISCUSSION: purulent pericarditis associated with gastrointestinal neoplasia may be due to sepsis or a proximity invasion . The diagnosis is based on ultrasound and pericardiocentesis. The most commonly involved organism is Streptococcus pneumoniae. The treatment involves intravenous antibiotics, pericardial drainage and intrapericardial instillation of antibiotics. The mortality rate remains high, especially in cases associated with gastrointestinal neoplasia.

Cas clinique : un patient de 63 ans, suivi pour une néoplasie du cardia généralisée, développe un épanchement péricardique associé à des signes de pré-tamponnade. Le CT scanner suggère la présence d'une fistule oeso- péricardique. Le drainage ramène un liquide purulent, et les analyses montrent une flore polymicrobienne. Malgré une antibiothérapie intraveineuse précoce par vancomycine et pipéracilline-tazobactam, le patient décède cinq jours après le drainage. DISCUSSION: les péricardites purulentes associées aux néoplasies digestives peuvent être secondaires à une septicémie ou à une atteinte de proximité. Le diagnostic est basé sur l'échographie cardiaque et la ponction du liquide péricardique. Le germe le plus fréquemment impliqué est le Streptococcus pneumoniae. Le traitement associe une antibiothérapie intra- veineuse, le drainage péricardique et l'instillation intrapéricardique d'antibiotiques. Le taux de mortalité reste élevé, particulièrement dans les cas associés aux néoplasies digestives.

Medical anticancer treatment of lung cancer associated with comorbidities: a review.

Comorbidities are frequent in patients with lung cancer, who are often treated with systemic anticancer therapy. The purpose of the present review is to report the adaptations recommended for the various drugs used in lung cancer treatment, in the context of a specific comorbidity. The literature was reviewed for neurologic, endocrine, hepatic, renal, digestive, cardiovascular, pulmonary, blood and systemic diseases. The comorbidities impact on the systemic anticancer treatment is poorly assessed. There are no good data with a high level of evidence and literature is often limited to experts' opinion and to case reports. We need to improve our knowledge about those patients by adequate multicentric and prospective studies and registries in order to offer them better care in term of evidence-based medicine.

Use of gentamicin in the treatment of access-port infections.

BACKGROUND: A therapy concept for access-port infections is presented. METHODS: Between January 2001 and May 2005, 556 adjustable gastric bands were placed laparoscopically, and access-port infection data were analyzed. 6 early infections and 1 late infection occurred. 2 early infections were treated successfully with placement of a PMMA-chain at the port-site--without port removal. 2 other early infections were treated successfully with port removal and later reconnection; however, infection recurred at the access-port soon after reconnection, so a PMMA-chain was positioned around the port. The last 2 early infections were treated successfully by port removal and later connection of a new access-port surrounded by a PMMA-chain. The late access-port infection appeared to be caused by gastric erosion. RESULTS: Complete healing was achieved in all cases of early infection, and follow-up revealed no complications with subsequent band adjustments. The gastric erosion required removal of the entire banding system. CONCLUSION: For early port infection, the placement of a PMMA-chain around the subcutaneous port appears to be a safe and effective approach that is less invasive than the usual port removal under general anesthesia. Placing the PMMA-chain is a rapid and simple procedure that allows retention of the original access-port. Once local healing is complete, the port can then be accessed easily and safely for band inflation.